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Thursday, December 11, 2014

The 12 Days of Pharmacy

On the Twelfth Day of Pharmacy, a patient said to me…
...let me speak to your manager.
...it's a drive-thru, not a stop and park.
...what's the best thing you got?
...you were s'posed to match the price.
...didn't my insurance work?
…how do I get a gift card?
...15 minutes? Why so long?

...it's just a box!
...just slap a label on it.
…saw my doctor send it.
...all you do is count by 5's!
...I thought antibiotics were free.

A Doctor sent to me...
12 duplicate e-scripts,
11 faxed copies of it,
10 voicemail messages,
9 patients expecting $4 copays,
8 illegible prescriptions,
7 narcs with no dea#
6 refill request denials,
5 prior auth rejections,
4 people told "it'll be ready for you"
3 scripts missing signatures,
2 scripts meant for another pharmacy,
and a patient expecting everything to be free!

Thursday, December 4, 2014

If the Real World Worked As People Believe the Pharmacy Does

Bank Teller: Thank you for coming into the bank. No one does anymore.
CP: And there are still just as few employees as there ever were.
BT: How may I help you?
CP: I should like to inquire as to the status of my payroll funds. They were to be direct deposited this morning.
BT: Do you have your account number?
CP: No. I have used other Bank of America locations before. Just look me up.
BT: But this is Chase.
CP: Aren't you all connected?
BT: No. No more than Walgreen's and Rite Aid share a computer.
CP: Oh. Well is my deposit here?
BT: I can't seem to locate it.
CP: What? They said it would be here. Can you check my friend's account? They sent our payroll at the same time.
BT: I show a deposit made today for that person, but nothing for you.
CP: What? I watched them send it. I put the direct deposit account info in myself and faxed it directly to payroll yesterday!
BT: It can take up to 2 weeks for it to get approved. Check your mailbox for a cheque.
CP: This is why I quit coming here to KeyBank.
BT: We are Chase.
CP: Can't you give me enough money to get through until my cheque arrives? I'm out. There's a great deal on Chia Pets at the local CVS and I need to stock up before they sell out.

Tuesday, December 2, 2014

Proof Pharmacy Exists Outside the Real World

CP: Good Morning and welcome to the first of the month where reality ceases to exist. How may I help you?
Dazed and Confused Mother: I need to fill this prescription for my son. He's never been here before.
CP: Welcome to you both. Let me get all your information.
DCM: I'm already in the system.
CP: Peachy. As you said, he is not. I shall need to enter him from scratch.
DCM: But I've been here before!
CP: And I've been to California before.
DCM: <Puzzled look>
CP: Do you have his insurance card?
DCM: No.
CP: I need it in order to process the prescription to it. Or I can charge you the exorbitant cash price of $5.00.
DCM: No way! He has insurance. It's Medicaid. <Looks at me expectantly>
CP: <Looks at her with matched expectancy>

hours pass…
DCM: Aren't you going to look it up?
CP: Question for you.
DCM: Okay.
CP: Did you have a good Thanksgiving?
DCM: Yes?
CP: Did you do some Black Friday shopping?
DCM: Of course.
CP: Get some good deals?
DCM: Yes. <explains a few purchases>
CP: How'd you pay?
DCM: Credit card.
CP: You knew you were going shopping, right?
DCM: Of course.
CP: You planned your trip? Which stores to hit? Who had the best deals? What to buy where? You made sure you had your purse and your wallet?
DCM: Yes.
CP: With your credit cards inside?
DCM: Duh!
CP: If you had made it all the way to the front of the line with your new 50" TV, XBox, and other purchases and realised you didn't have your credit card, would you have asked them to just look it up?
DCM: No. That's ridiculous.
CP: Do you think they would have called Visa simply because someone in your house had shopped there once before?
DCM: No.
CP: So you're expecting me to believe that you forgot your Welfare Credit Card, went to the doctor, received a prescription, knew you were coming to the pharmacy, and now you're expecting me to fix your problem for you? In what world are you living? Never mind the fact that you scoffed at $5 for this prescription but you just spent over $500 on new electronics last weekend.
DCM: So I should go home and get it?
CP: That would be ideal. Or you could return some items and scrape up the cash for the copay?
DCM: <Sends son to the car> He found it!
CP: Okay. That'll be 25 minutes to wait now.
DCM: What? Why so long?
CP: How long did you wait in line for all that crap you just bought? It's now 45 minutes.

Wednesday, November 26, 2014

Waiver Zone

I need a lawyer. Keeping in mind how much I love lawyers, this is a pretty big admission for me.
("If it wasn't for lawyers, we wouldn't need lawyers.")

It's not what you think, however.
I would like a lawyer to draft an exemption clause for me, for pharmacy, for those of us in the trenches. It will be an amnesty clause. Get out of jail free card.

Patients are so quick to blame the pharmacy for everything that stands between them and their medication. Building on the Disney Fast Pass Lane I want installed at my pharmacy, and adding to the $50.00 instant no-questions-asked flu shot fee, I want to add a special lane for "I'll Take My Chances".

The "I'll Take My Chances" (aka Russian Roulette) Lane will allow you to walk right over, sign a legal waiver absolving the pharmacy, pharmacist, and all its staff of any and all blame should any errors occur or fatal reactions ensue from a "Filled-Exactly-As-It-Was-Written" prescription. No questions asked. This will be more along the lines of "I Want It Right NOW" instead of "I Want It Right". Patients will accept full responsibility. I am sure we could have an attorney present at the table where these are signed to bear witness to the forfeiture of all future recriminations against anyone involved in filling these prescriptions.

Imagine the time we will save. No longer will our phone lines be tied up both ways (us calling prescribers for explanations and the patients calling us asking what is taking so long). No longer will we have to deal with the Charles Manson Stare Down as these patients will be placated in the knowledge their high-risk, high-reward prescriptions will be filled imminently. We can issue a 5 minute guarantee on this lane and have it staffed by one pharmacist and one technician at all times. There will of course be a surcharge imposed for this service but keep in mind, you are worth it!

We can even extend this to "one-and-done" on insurance billing. We will attempt to bill one, and only one, insurance for you. If it does not go through, requires prior authorization, or you are unsatisfied with the copay, your options become Take It OR Leave It. There will be no discussion, no pleas for what's behind Door #3. I am not Monty Hall. This is not a discussion. If you want fast service, know what you want and expect to pay for it. It will be like the Soup Nazi. No argument, no debate, no Rx for you. Next!

Tuesday, November 25, 2014

I'm Sorry.

Please allow me to apologise. I am sorry.
We hear this all the time. Some say it is human nature. Some will say it is conditioning. Some will say it is our parents' fault: always say "please and thank you "and apologise. I also think it is Corporate America's fault. If you say you are sorry, it will help defuse a situation. Maybe. My problem is that we offer apologies for everything today.

Your refill is too soon? I am sorry.
Your doctor didn't call in your prescriptions yet? I am sorry.
We told you to call us 2 days before you need your refill because it is a special order item and now you are out of it? I am sorry.
You think 20 minutes is too long to wait at 5pm on a Monday? I am sorry.
Your insurance changed and you left the card at home? I am sorry.
You planned a vacation and forgot to refill your medications until now…as you are en route to the airport? I am sorry.
Your prescriber wrote the prescriptions wrong and we had to call and he hasn't called back? Yep, Sorry...

Only I am NOT sorry. I am tired of that being our immediate, conditioned, pre-programmed response to people. I'm not sorry. Is that wrong? There are better ways to empathize with our patients. That's what we are trying to do-empathize with them. But it's erroneous. It's not MY fault so why am I the one who is saying I AM sorry?

Instead of "I'm sorry", let's try something else.

Mad Hatter: What do you mean he didn't send it? I was right there when he did it!
CP: Wow. That sucks dude. I feel your pain. Call them back and give them a swift kick in the ass. Next!

Mad Hatter: I am flying to London right now and need this filled ASAP!
CP: Well ASAP would be about 25 minutes. Thanks for giving me some time. I was afraid you wanted it, like yesterday.
MH: I do want it yesterday.
CP: Well, in the immortal words of Chad and Jeremy: "Yesterday's Gone". Safe travels. Next!

Mad Hatter: Why is this so expensive? Didn't you bill my insurance?
CP: Yes.
MH: That's it? Yes?!
CP: Yes, sir? Yes it is expensive. Yes we did bill your insurance. Yes they seem to suck at paying for really expensive things. It is the harsh reality of the world in which we live. Things cost money. I'd love to pay $1138 for a new Ferrari but it's not going to happen. You have the right to pay for it. You also have the right to leave it here and not pay for it. Please decide quickly as there are others behind who are waiting to make this difficult decision. Next!

Mad Hatter: I wish to register a complaint.
CP: Next!

Mad Hatter: I'm sorry that last guy was a twatscrew.
CP: No worries. And don't apologise for him or his behaviour. He's a big boy. Besides, always being right means never having to say you're sorry. (My apologies to Ali Mcgraw).

Monday, November 24, 2014

An Open Letter: Dear State Board of Pharmacy-Transfers

Dear YOUR State Board of Pharmacy,

My name is The Cynical Pharmacist and I am a licensed, practicing pharmacist in YOUR STATE. It is my mission today to ask you to outlaw prescription transfer incentives. While I understand the YOUR STATE Board is not in the business of regulating company practices, they are in the business of protecting their State's citizens.

Pharmacy is a profession. We expect to be treated as healthcare professionals. We expect to be respected as professionals. If we allow our services to be bartered for gallons of gas and free gift cards, we are nothing more than cheap hookers, a profession which does not require a license.

We pharmacists are not in the position to make these changes to our state laws. You are. You give us our licenses. You take them away. You write the laws that govern how pharmacy should be practiced in your state. We listen to you. It is time you listen to us.
There are several states that have already outlawed the incentivizing of prescription transfers. This list includes New York, New Jersey, Oregon, Alabama, Mississippi, New Hampshire, and Arkansas. Simply put, prescriptions are not commodities to be traded on the retail market. These are life-altering medications that make a huge impact on a patient's life.

My concern with continued acceptance of this practice in YOUR STATE goes deeper than transfer errors. It goes deeper than the possibility of mistakes. It goes deeper than missing interactions and therapeutic duplications. It is about perception. We are the most accessible professional in all of healthcare. We gladly give away all of our professional services for free. The problem isn't companies attempting to buy patient loyalty. Studies have shown less than a 20% retention rate on patients who use coupons and incentives. The problem is lack of respect that arrives as a side effect with these programs. If we do not respect ourselves, we simply cannot expect our patients, and even other healthcare professionals, to respect us. I am starting a campaign to take my profession back. It starts with your help.

I have broached this subject directly with my State Board in the past. I have spoken with other pharmacists who have also contacted their State Boards and had similar results. The Boards' refusals to enter this discussion often boil down to the following argument: The Board does not exist to regulate company policy. I have mentioned each of the following situations before and received the equivalent of a shoulder shrug from those with whom I spoke. According to these members, the following are simply anecdotal and they have no proof that these can happen, do happen, and even if they did, the frequency with which they actually occur.

1. The risk for errors increases each time a prescription is transferred. The more times you fill it, delete it, call it in to another pharmacy, and give a verbal order to someone else, the risk increases. (Think of the telephone game in kindergarten.)

2. Time is wasted on transfers for coupons that could be spent on any other professional task. Each time I have to step away to get a transfer or give a transfer for a patient, I am at risk of speeding through something to catch up. I may miss a drug interaction. I may dispense an incorrectly filled prescription. The risk that I may make an error increases.

3. Patients complain about not being able to shop around or "going South" for the winter. There are states that only allow single transfers. Simple. If the rules exist, patients will adjust to them. They will get two prescriptions: one for home and one for their desert oasis. (Think about how well everyone adjusted to no refills on Hydrocodone-containing products recently.) Also, with most insurance plans, the patients' copays are the same at nearly every pharmacy. They shouldn't need to shop it around.

4. Grown adults use their elderly parents' medications to make money. This is true. I have seen it firsthand. Do the parents know? Is that their right? We have people who will carry folders with their parents' prescription receipts from all the local pharmacies. Every week they will drive from pharmacy to pharmacy, transferring CVS to Target, Target to Walgreen's, Walgreen's to Rite Aid, Rite Aid to Wal-Mart. Next week, they repeat the process. This should not be allowed to happen. If an error occurs, who will get in trouble? The pharmacies. Who will pay the price? The elderly parent. Your job as State Board involves looking out for the health and wellbeing of your citizens. 

Patients will complain states are taking away their rights. I believe they are taking advantage of a system that never should have existed in the first place. We need to make our profession more professional. It starts with you. It starts with this law change. It has to start now. I want my profession back. Please.

I would be happy to attend a Board meeting to discuss my proposal further.

Thank you for your time and consideration.

I have included a link to Alabama’s law, a state that changed most recently.

“A pharmacist and a pharmacy should never offer or participate in the offering a financial award or benefit, not related to competitive retail pricing of any drug, to induce or encourage any individual to transfer a prescription from one pharmacy to another.”

Statutory Authority:
effective June 13, 2011. Amended: December 16, 2011; effective January 20, 2012.
Herb Bobo, R.Ph. Secretary
Code of Alabama 1975; §34-23-92.
Original rule filed: May 30, 1990; Effective July 30, 1991; Amended: May 9,

Here is the verbiage currently proposed in Virginia.


Thursday, November 20, 2014


If you want to sell a product, people need to know you have it available to sell.
Think about product placement. It's all marketing and psychology. 
Companies pay top dollar to have their products placed in strategic locations, whether it be end caps or eye level on store shelves. 
Remember the old department stores that had huge window displays? 
Think about car dealers. Chevy has the newest, shiniest Corvette sitting prominently in the showroom. You can see it from the street. You are invited to look at these products. You cannot help yourself. 

(CP, what the hell does this have to do with pharmacy?)

Many pharmacies have a window, glass wall, barrier, something between the pharmacy staff counter and the general population strolling around out front. Most pharmacies keep their fastest movers on this ledge...or maybe just their Amoxicillin, Percocet and Norco because they are the biggest frequent flyers. In every pharmacy I have worked, we have had a variation of this. I always find it a little amusing when the Powers That Be saunter through our department and chastise us for having these items in a prominent location. It's bullet resistant glass. It's nice to know you are more worried about an open bottle of Norco behind a window than you are about my safety behind open counters. 

To me, this is marketing at its finest. 
Remember not too long ago when the Hydrocodone products were on backorder? (Except at my store where we anticipated the shortage.) I figured proper product placement in the window was the perfect way to show people we had what they sought.

As people would walk by they would espy the pretty bottles of 512's and Norcos in the window. They'd begin to drool at the mere sight. Pavlovian response underway, they'd call all their friends and say: "Hey, guess what? We found that Norco you were looking for. It's right here in the window display under the Christmas tree with the turkey ornaments and menorahs. Come quick before they sell out!"

When corporate would ask why our numbers were up double digits in prescription sales we'd laugh and tell them about our Jolly Multi-Holiday C-II display…then they'd complain because the decorations weren't approved, we didn't suggestive sell flu shots to all of them and we only advertised low profit margin generics.

Seriously, though. What is the difference between having a bottle 8 inches in front of me, on a ledge, versus 3 feet behind me? Patients can see my entire pharmacy inventory as they walk by. Thanks to the open-concept floor plan, the only thing that doesn't flow through my pharmacy is the front end aisle. Listen to me Oh Great and Powerful Powers That Be: You cannot insist I close my door and keep select products under lock-and-key if you are going to leave 30 linear feet of waist-high counter open to the general public. You CLEARLY are not concerned about the safety and wellbeing of your employees. You are plainly telling me that the few dollars invested in a couple bottles is worth more to you than our lives. (No. It is not a safety issue. Someone doesn't just walk by, see some controls on a ledge and decide to rob the pharmacy.) For you, it is all about the inventory…which still makes no sense. It's like leaving your garage door up at night with the lights on and the door to the house ajar, but locking your bathroom door during your middle of the night micturition trip. 

Wednesday, November 19, 2014

A(nother) Debate with Myself

Me: Why are you here?
CP: Existentially, philosophically, or?
Me: Professionally.
CP: I am a pharmacist.
Me: But why retail? You so hate your job.
CP: No I don't.
Me: But all your posts are so negative and mean. You must really hate people.
CP: I don't know half of them half as well as I should like; and I like less than half of them half as well as they deserve.
Me: Okay. But it is because that's where the money is?
CP: Nope.
Me: Then what is it? And don't say "to help people".
CP: Why not?
Me: Because that is the worst interview answer ever.
CP: Okay. How about this?: To foster and promote an environment where a healthy dialogue and transaction can take place enabling patients to get a better understanding of what it means to take better care of themselves and to enable them to reach these goals on their own.
Me: Verbose. Explain. Succinctly.
CP: I still believe people are good. I still believe they come to us for their healthcare needs, now more than ever with the other services we provide. This will continue to grow. We are the face of healthcare. We are the easiest professionals to reach directly. People like us.
Me: But you always complain they hate you.
CP: They do and they don't. Hate the game. Love the player. Many people understand that. Someone once asked me in an interview what my favourite thing about my job was. I quickly answered: My patients. I love them. I love getting to know them and their families. I love knowing what they are taking so I can help them with any questions they have. I love they feel comfortable enough to ask me questions and just talk with me whenever they need it.
Me: Aw. How sweet.
CP: Then I was asked about my least favourite thing about my job.
Me: Go on.
CP: I answered: The patients. The whiny, I-need-everything-now, slap-a-label-on-it, yelling, screaming, entitled, I'm-going-to-call-corporate-on-you, hurry-up-what's-taking-so-damn-long, stare-me-down IMpatients that we all deal with every day.
Me: Nice. Did you get the job?
CP: Of course I did.
Me: Back to the question: Why ARE you here?
CP: I serve a bigger purpose than myself. I believe I can do my best work in retail. I have the knack for patient service. I'm good enough, I'm smart enough, and doggone it, people like me. It's like bedside manners for prescribers. Those who are great at it are often lacking in other areas. Those who suck at it are often brilliant practitioners. There are few who can find the happy medium. I am somewhere on that Bell Curve. Another area of practice would have fit in with my brain a little better but I am a talker and love to engage people in conversation.
Me: But you complain a lot.
CP: Sure. Look at where it's brought me. I am bringing to light many problems facing our profession today. Retail seems to be looked down upon by other professions and other professionals within the practice of pharmacy even though we represent the majority of practicing pharmacists employed today. We have a job to do. It is evolving. It has moved away from its "helping patients" credo and become "dollar grabber extraordinaire" with all its ancillary, a la carte services.
Me: What do you wish to do about it?
CP: I want my profession back.
Me: And how will you accomplish that?
CP: Stay Tuned...With this page. I have a few ideas in the works, but I need input from all my followers. Hence the Participation Polls I am conducting. Some assembly required. It's like class participation. The more you participate, the better the class does.